Provider Demographics
NPI:1902585912
Name:REVIVE AND RESTORE COUNSELING, PLLC
Entity Type:Organization
Organization Name:REVIVE AND RESTORE COUNSELING, PLLC
Other - Org Name:REVIVE AND RESTORE COUNSELING, PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:LMFT, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUKES
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:469-740-5832
Mailing Address - Street 1:5030 HUFFINES BLVD
Mailing Address - Street 2:
Mailing Address - City:ROYSE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75189-2443
Mailing Address - Country:US
Mailing Address - Phone:972-834-5449
Mailing Address - Fax:
Practice Address - Street 1:5030 HUFFINES BLVD
Practice Address - Street 2:
Practice Address - City:ROYSE CITY
Practice Address - State:TX
Practice Address - Zip Code:75189-2443
Practice Address - Country:US
Practice Address - Phone:972-834-5449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-17
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty